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A doctor’s condolences

When a patient dies in the hospital, we go through a checklist that has become eerily mundane: Examine the patient to confirm the death. Notify the family, the senior doctor, the local organ bank, the admitting office, and (in some cases) the medical examiner. Fill out the report of death. Write a death note. Brace yourself against the emotional weight of the event and get on with your work. Nowhere in that process is a responsibility that should predate our medical training: the condolence letter.

I’d never written one for a patient until last week in the Intensive Care Unit when our team’s attending doctor brought up the idea. Instead of a fountain-penned, monogrammed note, ours was typed on hospital letterhead and signed with ballpoint pens. But it was a tribute all the same to what has become a dying tradition among doctors.

It’s a shame that the letter of condolence has gone the way of penicillin and the black leather medical bag. Part of the trouble, at least in the hospital, is that we may not know patients as well or for as long as we used to: hospital stays are now measured in days instead of weeks and residents work fewer, often odd, hours to comply with duty hour requirements. Working in teams, we often shift which doctor has primary responsibility for a given patient so niceties like letter-writing are more likely to get lost in the shuffle.

Ishani is a journalist and a second-year resident in internal medicine/primary care at Massachusetts General Hospital. She blogs at Short White Coat. Ishani’s blogs are reprinted on healthydebate.ca with the permission of the author. Follow Ishani on Twitter @IshaniG.

I have been writing these letters for some time. I did not do this early in my practice, and there felt like there was something missing. What I have found in the writing of this letter is that it helps provide closure for the physicians as well as the family. It allows me to acknowledge the suffering that I feel (arising no doubt from that latent sense that I did not get the job done) in a manner that is more healthy and helpful than recrimination and self doubt. It offers me a time during my day when, because of the nature of the letter, I will have to sit quietly for a moment and gather my thoughts about the events that have transpired. It asks me to reflect upon the life that was led, the purpose and role of the deceased, and my role in their life and death. It allows me the moment of sorrow for loss and gratitude for the time we are all given. It serves to remind me of the things that are important so that I do not treat them with casual familiarity as I acknowledge that they may be gone sooner than I realize. For the patients for whom I have developed a relationship, it allows me the chance to say a final thank you for being made a part of their lives with all the joy and sorrow that they hold, and reminds me again to be grateful for the patients I still have the good fortune to be able to greet on a daily basis.

I hope your negative comments only reflect an off moment. It all comes down to your personal choice. What do you want to stand for, what type of health care do we want to provide – clearly not what you have stated here.

The compassionate letter is not to be underestimated. The following handwritten letter was posted under the title “This letter from my late mother’s doctor has changed my life” and can be viewed here. http://imgur.com/pekfXzk You will add to the current total of 2,192,602 views.
Here’s a transcript:

Dear Mr. ______________,

I am the Emergency Medicine physician who treated your wife Mrs. __________ last Sunday in the Emergency Department at the New York Presbyterian Hospital. I learned only yesterday about her passing away and wanted to write to you to express my sadness. In my twenty years as a doctor in the Emergency Room, I have never written to a patient or family member, as our encounters are typically hurried and do not always allow for more personal interaction. However, in your case, I felt a special connection to your wife __________ who was so engaging and cheerful in spite of her illness and trouble breathing. I was also touched by the fact that you seemed to be a very loving couple. You were highly supportive of her, asking the right questions with calm, care and concern. From my experience as a physician, I find that the love and support of a spouse or a family member is the most soothing gift, bringing peace and serenity to those critically ill.

I am sorry for your loss and I hope you can find comfort in the memory of your wife’s great spirit and of your loving bond. My heart felt condolences go out to you and your family.

Thanks for writing about this. On a few occasions, I have posted online condolences for patients when the funeral home provided the service. It actually provided a sense of personal satisfaction that I completed my service to that patient and family. I am not sure why I don’t do something like this more often – thanks for the reminder!

This document is provided under the terms of a CreativeCommons Attribution Non-commercial Share Alike license. The terms of the license are available at: http://creativecommons.org/licenses/by-nc-sa/3.0/. Attributions are to be made to HealthyDebate.ca, a project under the direction of Dr. Andreas Laupacis, at the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital.